BACKGROUND. VA has lead the industry in measuring facility performance as a critical element to improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. VA's External Peer Review Program (EPRP) is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care as well as overall quality, however, much variability still exists both in mean levels and improvement levels of performance across measures and facilities. Audit and feedback, an important component of effective performance measurement, can help reduce this variability and improve overall performance; previous research by the principal investigator suggests that VAMCs with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data is used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high performing facilities is thus urgently needed. OBJECTIVE. This research explores specific ways in which leaders at high and low performing facilities use and feed back EPRP data to maintain and improve performance at their facilities. METHODS. Qualitative, grounded theory analysis of up to 60 interviews with primary care, facility and VISN leadership of high, moderate, and low performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness of feedback delivery. We will follow this qualitative analysis with a web- based survey of primary care personnel at 18 facilities to examine perceptions of the utility of EPRP data as a feedback source as well as the extent to which EPRP and other sources of data (if any) are delivered in a timely, individualized, and non-punitive manner.